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At least 991 records · Page 55Linked to original sources
PubMed2000

[A case of rheumatoid arthritis associated with autoimmune hemolytic anemia due to weekly low-dose methotrexate therapy].

A 57-year-old woman was found to have rheumatoid arthritis (RA) in 1996. Treatment with different immunoregulatory agents, including actarit and bucillamine, produced no improvement. Therefore, combined therapy with methotrexate (MTX) (5 mg/week oral) and low-dose prednisolone (PSL) (5 mg/day) was started in April 1997. Sulindac and famotidine were also administered. In August 1997, she was admitted to our hospital because of palpitations and shortness of breath due to severe anemia. Results of laboratory studies were hemoglobin, 2.9 g/dl; reticulocyte count, 225/1000; and haptoglobin, less than 10 mg/dl. The direct and indirect Coombs'tests were positive. A diagnosis of autoimmune hemolytic anemia (AIHA) was made on the basis of the laboratory findings. Treatment with high-dose PSL (50 mg/day) was started, and the anemia improved. The hemoglobin level increased to 6.0 g/dl within the 1st week and to 12.6 g/dl 6 weeks later. We believe that the most likely explanation for this anemia was the low-dose MTX because the anemia appeared soon after treatment was started.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

Clinical phase I trial of inosine dialdehyde (NSC-118994).

An initial clinical phase I trial of inosine dialdehyde has been carried out in 40 patients at dose levels of 30-4000 mg/m2 for 5 days given intravenously (iv) monthly. At 1.5 g/m2, noncumulative dose-related toxicity occurred in all patients which consisted of nausea and vomiting, local pain, alterations in coagulation mechanism, elevated partial thromboplastin time, and positive Coombs' test. No dose-limiting leukopenia, thrombocytopenia, anemia, or bleeding occurred; however, depression of the leukocyte and platelet counts, and decreased hemoglobin value were observed. The dose-limiting toxic effect was renal tubular damage with reversible acute renal failure in one of four patients who received 3000 mg/m2 iv for 5 days. Refractory hypercalcemia was controlled in three of three patients without tumor effect. Responses occurred in patients with seminoma, oat cell carcinoma, and melanoma. A starting dose of 2 g/m2 for 3 days monthly is recommended for phase II trials and a trial in lung carcinoma is now being conducted.

Aldehydes↗
PubMed2000

Alloimmunization and erythrocyte autoimmunization in transfusion-dependent thalassemia patients of predominantly asian descent.

The development of hemolytic alloantibodies and erythrocyte autoantibodies complicates transfusion therapy in thalassemia patients. The frequency, causes, and prevention of this phenomena among 64 transfused thalassemia patients (75% Asian) were evaluated. The effect of red blood cell (RBC) phenotypic differences between donors (mostly white) and Asian recipients on the frequency of alloimmunization was determined. Additional transfusion and patient immune factors were examined. 14 (22%) of 64 patients (75% Asian) became alloimmunized. A mismatched RBC phenotype between the white population, comprising the majority of the donor pool, and that of the Asian recipients, was found for K, c, S, and Fyb antigens, which accounts for 38% of the alloantibodies among Asian patients. Patients who had a splenectomy had a higher rate of alloimmunization than patients who did not have a splenectomy (36% vs 12.8%; P =.06). Erythrocyte autoantibodies, as determined by a positive Coombs test, developed in 25% or 16 of the 64 patients, thereby causing severe hemolytic anemia in 3 of 16 patients. Of these 16, 11 antibodies were typed immunoglobulin G [IgG], and 5 were typed IgM. Autoimmunization was associated with alloimmunization and with the absence of spleen (44% and 56%, respectively). Transfused RBCs had abnormal deformability profiles, more prominent in the patients without a spleen, which possibly stimulated antibody production. Transfusion of phenotypically matched blood for the Rh and Kell (leukodepleted in 92%) systems compared to blood phenotypically matched for the standard ABO-D system (leukodepleted in 60%) proved to be effective in preventing alloimmunization (2.8% vs 33%; P =.0005). Alloimmunization and autoimmunization are common, serious complications in Asian thalassemia patients, who are affected by donor-recipient RBC antigen mismatch and immunological factors.

Adolescent↗
PubMed2000

[Autoimmune hemolytic anemia].

Autoimmune hemolytic anemias (AIHAs) are the most ancient and well known example of clinical autoimmunity. They may be still distinguished in two main groups, that is with "warm" or "cold" antibodies, according to the optimal temperature at which they react with the erythrocyte antigens in vivo and in vitro. There is also a subgroup where both kinds of autoantibodies coexist. AIHAs may be idiopathic or secondary. The immunologic techniques for the demonstration of the antibodies are well established, but one must remember that there are infrequent cases with negative DAT (Coombs) test when performed with conventional procedures. The fundamental concepts of therapy are discussed, and the detailed review of the principal procedures is performed, including blood transfusions (when and how), plasma exchanges, high-dose immunoglobulins, glycocorticosteroids, splenectomy, cytotoxic agents and stem cell transplantation, autologous and allogeneic.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

[Valve of detection of the Du blood group factor in hospital transfusion practice].

Following a description of factor Du, a variant of factor D, a personal series of about 3% is described and the technique using indirect Coombs test is indicated. Identification of factor Du takes on importance in the prophylaxis of post-transfusional isoimmunization as donors of Rh negative blood with Du positive must be considered Rh positive donors.

Blood Group Incompatibility↗
PubMed1975

[Serodiagnosis of human brucellosis].

On the basis of the serological study of 1000 sera obtained from patients suspected of suffering from brucellosis, the authors emphasis the theoretical data which confer upon this complement fixation reaction a greater reliability than the agglutination reaction. Using an appropriate antigenic preparation, the complement fixation reaction indeed proves to be of greater interest than the classical Wright sero-agglutination test in the diagnosis of brucellosis.

Antibodies, Bacterial↗
PubMed2001

Spectrum of outcome in infants with extreme neonatal jaundice.

UNLABELLED: The increasing number of case reports on neurologic sequelae related to hyperbilirubinaemia may represent a re-emergence of kernicterus in the industrialized world. However, not much has been written about infants who survived extreme levels of serum bilirubin without neurologic damage. We present three cases of extreme neonatal hyperbilirubinaemia, all with peak serum bilirubin levels >600 micromol/L. Two of the infants developed neurologic sequelae, but the third infant did not. In contrast to the two with sequelae, the infant without sequelae was female, had a positive Coombs' test, less clinical signs compatible with bilirubin encephalopathy, and a shorter exposure to serum bilirubin values >400 micromol/L. CONCLUSION: The basic mechanism of bilirubin neurotoxicity remains unknown, and it is not clear why some infants do not develop neurologic injury at serum bilirubin levels at which others do. We speculate that a comparison between patients with sequelae and those without may yield important information.

Bilirubin↗
PubMed1999

[The clinical implications of IgG subclass in 84 patients with autoimmune hemolytic anemia].

OBJECTIVE: To evaluate the clinical implications of IgG subclass in autoimmune hemolytic anemia(AIHA). METHODS: Data of 84 AIHA patients were retrospectively analyzed. RESULTS: In the 84 patients, IgG1 + IgG3 + C3d accounted for 45.0%, IgG1 + IgG3 15.5%, IgG1 + C3d 11.0%, C3d 10.7%, IgG1 9.5% and IgG3 + C3d 8.3%. IgG3 patients had the most severity of clinical and laboratory findings, followed by IgG1 patients. In IgG1 and IgG3 subgroups, the severity of hemolysis was positively correlated with the score of Coombs' test. The response rates of IgG3 and IgG1 patients were 68.2% and 100%, respectively. CONCLUSION: In AIHA, the basic predominant IgG subclass is IgG1. IgG3 has a greater potential for red-cell destruction than IgG1 and C3d.

Adolescent↗
PubMed2001

[Autoimmune hemolytic anemia].

From the beginning of the century, autoimmune haemolytic anaemia (AIHA) was the first model of an auto-antibody mediated disease. Despite the variety of the clinical features, the diagnosis of AIHA provides few difficulties since the introduction of the popular Coombs' test. The clinical presentation of AIHA depends on the subclass type and on the thermal range activity of the causative auto-antibody, so that two main pictures occur usually: warm auto-antibody and cold auto-antibody types, the latter being less frequent than the former. In more than half the cases, AIHA is associated with another disease that must be considered more as the background of immune dysregulation than the cause of the disease. Systemic disorders, chronic lymphoid malignancy, primitive or acquired immunodeficiencies are the most common disorders associated with AIHA. Acute infections or drugs may give rise to acute transient AIHA. The clinical aspects and the links between AIHA and associated diseases are emphasised. No decisive advancement in therapy has arisen over the last decades. Some patients are still resistant to all therapeutic manoeuvres and may die. Much labour is to be done in order to discover more rational methods of therapy to restore a state of normal tolerance towards erythrocyte auto-antigens. Suppressing the production of pathogenic auto-antibodies by immunomodulation may be the first step of this task.

Acute Disease↗
PubMed2001

[Angioimmunoblastic T-cell lymphoma with hyperplastic germinal centers].

We report a case of angioimmunoblastic T-cell lymphoma (AITL) in a 48-year-old Japanese male. Characteristic clinical manifestations of AITL such as fever, weight loss, skin rash, general lymphadenopathy, Coombs test positivity, and polyclonal hypergammaglobulinemia were present. Histopathologically, the nodal architecture was preserved and germinal centers were, if anything, hyperplastic, which was unusual for AITL. Diagnostic clear cells were absent. Intrafollicular tingible-body macrophages were markedly increased. In the interfollicular zone, proliferation of UCHL-1 + immunoblasts was evident, and high-endothelial postcapillary venule-type vessels were increased. The T-cell receptor gene (C beta 1) was clonally rearranged. Based on these findings, a diagnosis of AITL with hyperplastic germinal centers was made. Six courses of CHOP were administered and no signs of relapse were noticed about two years after diagnosis.

Diagnosis, Differential↗
PubMed1999

[Immunologic thrombopenic purpura associated with an autoimmune hemolytic anemia or Fisher-Evans syndrome: apropos of a case].

We report one case of thrombocytopaenia purpura associated with an auto-immune haemolytic anaemia (positive erythrocyte Coombs test) or Fisher-Evans syndrome, found in a child aged 6 and a half years. Etiopathogenic, clinical, therapeutic as well as evolutive aspects are discussed. Response to corticoids is satisfactory in case our patient, in opposite to most cases described in the literature.

Anemia, Hemolytic, Autoimmune↗
PubMedDate not supplied

[Specific features of acute renal failure in patients treated with rifampicin].

This retrospective study was performed on 92 patients diagnosed with acute renal failure (ARF) post discontinuous rifampicin treatment, admitted between 1974-2000, in Hemodialysis Center of 1st Timisoara Clinical County Hospital. The passage from the continuous treatment (7/7) to discontinuous RMP treatment triggered the ARF in 77 patients and the restart of the treatment after one year or more of treatment arrest, lead to ARF in 15 cases. The ARF symptomatology appeared in the first 12 hrs of treatment resumption in 14.13% cases and in 85.87% after 38.5 +/- 8.2 hrs. The most frequent symptoms were lumbar pain in 76.08%, nausea and vomiting in 60.86%, abdominal pain (52.17% of cases) flu-like (fever, chills, myalgia), jaundice, diarrhea, hypotension, confusion and hypertension in only 7.6% of cases. In 94.56% of cases renal symptoms appeared in normal kidneys. The renal injury evolution was favorable, with significant improvements after 20 days in serum and urine biological parameters. The antibodies anti-RMP were present in serum 55.43% of patients, in 80.39% of them, the presence of antibodies was related to high values of gamma-globulins. In 33.69% of patients sterile leukocyturia, considered a marker of interstitial nephritis, was present. The most frequent associated ARF complications were the hemolytic anemia emphasized by high levels of unconjugated bilirubin and positive Coombs' test in 93.3% of patients, and liver injuries, present in 41.69% of cases. Thrombocytopenia was registered in 27.7% of cases, infections in 28.6%, gastrointestinal complications in 11.95%, and cardiovascular complications in 9.78% of cases, these severe forms leading to the death of patients. The ARF post discontinuous rifampicin treatment presents a favorable evolution even when it is associated with other organ or systems complications. The ARF and associated complications are due to the specific immune system activation by rifampicin, and by direct toxic effects of rifampicin at tissues level.

Acute Kidney Injury↗
PubMed1975

[4 cases of hemolytic autoimmune anemia and idiopathic thrombopenic purpura with anti-native DNA antibodies].

Four cases (1 female and 3 male) of autoimmune hemolytic anemia (AHA) and idiopathic thrombocytopenia purpura of 13-34 years' duration are reported. All have antibodies against native DNA, low complement levels and positive Coombs test. In 2, circulating immune complexes were found. Renal biopsies in 3 revealed small deposits of immunoglobulin and complement in the mesangium of glomerula. No inflammatory changes were seen in light microscopy. These patients thus resemble the animal model of NZB mice, which exhibit similar AHA with antibodies to DNA but with minimal renal changes.

Adult↗
PubMed2002

[Angioimmunoblastic T cell lymphoma (AITL) with autoimmune thrombocytopenia].

We present a case of angioimmunoblastic T cell lymphoma (AITL) with autoimmune thrombocytopenia. A 85-year-old man was admitted to our hospital with thrombocytopenia, generalized lymphadenopathy, pleural effusion, and splenomegaly in June 2000. Blood chemistry revealed hemoglobin and platelet counts of 8.8 g/dL and 26 x 10(9)/L, respectively. The level of platelet-associate-IgG was 2568.9 ng/10(7) cells. The direct Coombs test was positive. The level of serum IL-6 was 10.2 pg/ml. Megakaryocytes in the bone marrow increased. Lymph node biopsy showed diffuse proliferation of atypical lymphoid cells with a clear cytoplasm accompanied by plasma cells and small vessels. He was diagnosed as having AITL with autoimmune thrombocytopenia and hemolytic anemia. He received repeated platelet transfusion, and a limited effect of prednisolone therapy on his platelet count was observed. Combination chemotherapy lessened the extent of the lymphadenopathy and slightly elongated the interval of platelet transfusion. We next performed splenic irradiation and a slight increase in the platelet count was observed. He died of pneumonia in August 2000. Autoimmune thrombocytopenia associated with AITL is rare and the therapy containing prednisolone and chemotherapy is reported to be partly effective. Our case showed a minor response of autoimmune thrombocytopenia to splenic irradiation. Therapeutic intervention for hypersplenism should be considered if thrombocytopenia is not improved by chemotherapy alone.

Aged↗